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The objective of this study was to evaluate the racial and ethnic disparities in delivery hospitalizations involving severe maternal morbidity (SMM) by location of residence and community income. We used the 2016 to 2019 Healthcare Cost and Utilization Project National Inpatient Sample. International Classification of Diseases, Tenth Revision, Clinical Modification codes were used to identify delivery hospitalizations with SMM. Using logistic regression models, we examined the association between race and ethnicity and delivery hospitalizations involving SMM. In adjusted analyses, the models were stratified by location of residence and community income and adjusted for patient and hospital characteristics. In rural areas, non-Hispanic Black women (AOR 1.50; 95% CI 1.25-1.79) and women of other races (AOR 1.32; 95% CI 1.03-1.69) had an increased odds of experiencing a delivery hospitalization involving SMM when compared to non-Hispanic White women. In micropolitan areas, non-Hispanic Black women (AOR 1.88; 95% CI 1.79-1.97), non-Hispanic Asian/Pacific Islander women (AOR 1.54; 95% CI 1.16-2.05), and women of other races (AOR 1.31; 95% CI 1.03-1.67) had an increased odds of experiencing a delivery hospitalization involving SMM when compared to non-Hispanic White women. Non-Hispanic Black women also had increased odds of experiencing a delivery hospitalization involving SMM in communities with the lowest income (quartile 1) (AOR 1.59; 95% CI 1.49-1.66), middle income (quartiles 2 and 3) (AOR 1.81; 95% CI 1.72-1.91), and highest income (AOR 2.09; 95% CI 1.90-2.29) when compared to non-Hispanic White women. We found that location of residence and community income are associated with racial and ethnic differences in SMM in the United States. These factors, outside of individual factors assessed in previous studies, provide a better understanding of some of the structural and systemic factors that may contribute to SMM., (© 2024. The Author(s).)

Black childbearing individuals in the US experience a higher risk of postpartum weight retention (PPWR) compared to their White counterparts. Given that PPWR is related to adverse health outcomes, it is important to investigate predictors of weight-related health behaviors, such as self-weighing (i.e., using a scale at home). Regular self-weighing is an evidence-based weight management strategy, but there is minimal insight into sociodemographic factors related to frequency. The Postpartum Mothers Mobile Study (PMOMS) facilitated longitudinal ambulatory weight assessments to investigate racial inequities in PPWR. Our objective for the present study was to describe self-weighing behavior during and after pregnancy in the PMOMS cohort, as well as related demographic and psychosocial factors. Applying tree modeling and multiple regression, we examined self-weighing during and after pregnancy. Participants (N = 236) were 30.2 years old on average (SD = 4.7), with the majority being college-educated (53.8%, n = 127), earning at least $30,000 annually (61.4%, n = 145), and self-identifying as non-Hispanic White (NHW; 68.2%, n = 161). Adherence to regular self-weighing (at least once weekly) was highest among participants during pregnancy, with a considerable decline after giving birth. Low-income Black participants (earning < $30,000) were significantly less likely to reach a completion rate of ≥ 80% during pregnancy (AOR = 0.10) or the postpartum period (AOR = 0.16), compared to NHW participants earning at least $30,000 annually. Increases in perceived stress were associated with decreased odds of sustained self-weighing after delivery (AOR = 0.79). Future research should consider behavioral differences across demographic intersections, such as race and socioeconomic status, and the impact on efficacy of self-weighing., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Purpose: To examine the association between intensive, longitudinal ecological momentary assessment (EMA) and self-reported eating behaviors., Methods: Secondary analysis of the EMPOWER study-a 12-month observational study that examined the microprocesses of relapse following intentional weight loss using smartphone-administered EMA-was conducted. Participants were asked to complete four types of EMA surveys using a mobile app. For this analysis, only the number of completed random EMA surveys was used. Using linear mixed-effects modeling, we analyzed whether the number of completed random EMA surveys was associated with changes in self-reported dietary restraint, dietary disinhibition, and susceptibility to hunger measured using the Three-Factor Eating Questionnaire (TFEQ)., Results: During the 12-month study, 132 participants completed a mean of 1062 random EMA surveys (range: 673-1362). The median time it took for participants to complete random EMA surveys was 20 s and 90% of random EMA surveys were completed within 46 s. The number of completed random EMA surveys was not significantly associated with the TFEQ scores., Conclusions: Intensive longitudinal EMA did not influence self-reported eating behaviors. The findings suggest that EMA can be used to frequently assess real-world eating behaviors with minimal concern about assessment reactivity. Nonetheless, care must be taken when designing EMA surveys-particularly when using self-reported outcome measures., Level of Evidence: Level III, prospective observational study., (© 2023. The Author(s).)

Wastewater surveillance has proven to be an effective tool to monitor the transmission and emergence of infectious agents at a community scale. Workflows for wastewater surveillance generally rely on concentration steps to increase the probability of detection of low-abundance targets, but preconcentration can substantially increase the time and cost of analyses while also introducing additional loss of target during processing. To address some of these issues, we conducted a longitudinal study implementing a simplified workflow for SARS-CoV-2 detection from wastewater, using a direct column-based extraction approach. Composite influent wastewater samples were collected weekly for 1 year between June 2020 and June 2021 in Athens-Clarke County, Georgia, USA. Bypassing any concentration step, low volumes (280 µl) of influent wastewater were extracted using a commercial kit, and immediately analyzed by RT-qPCR for the SARS-CoV-2 N1 and N2 gene targets. SARS-CoV-2 viral RNA was detected in 76% (193/254) of influent samples, and the recovery of the surrogate bovine coronavirus was 42% (IQR: 28%, 59%). N1 and N2 assay positivity, viral concentration, and flow-adjusted daily viral load correlated significantly with per-capita case reports of COVID-19 at the county-level (ρ = 0.69-0.82). To compensate for the method's high limit of detection (approximately 10 6 -10 7 copies l -1 in wastewater), we extracted multiple small-volume replicates of each wastewater sample. With this approach, we detected as few as five cases of COVID-19 per 100 000 individuals. These results indicate that a direct-extraction-based workflow for SARS-CoV-2 wastewater surveillance can provide informative and actionable results., Competing Interests: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of FEMS.)

Physical activity (PA) estimates from the Fitbit Flex 2 were compared to those from the ActiGraph GT9X Link in 123 elementary school children. Steps and intensity-specific estimates of PA and 3-month PA change were calculated using two different ActiGraph cut-points (Evenson and Romanzini). Fitbit estimates were 35% higher for steps compared to the ActiGraph. Fitbit and ActiGraph intensity-specific estimates were closest for sedentary and light PA while estimates of moderate and vigorous PA varied substantially depending upon the ActiGraph cut-points used. Spearman correlations between device estimates were higher for steps ( r s =.70) than for moderate ( r s =.54 to .55) or vigorous ( r s =.29 to .48) PA. There was low concordance between devices in assessing PA changes over time. Agreement between Fitbit Flex 2 and ActiGraph estimates may depend upon the cut-points used to classify PA intensity. However, there is fair to good agreement between devices in ranking children's steps and MVPA.

Wildland firefighters (WLFFs) are exposed to a mixture of chemicals found in wildland fire smoke and emissions from nonwildland-fuel smoke sources such as diesel. We investigated compositional differences in exposure to particulate matter and explored differences in ventilation rate and potential inhaled dose relative to the work tasks of WLFFs. Repeated measures on ten professional and two volunteer firefighters were collected on prescribed burn and nonburn days. Personal monitoring consisted of real-time and gravimetric fine particulate matter (PM2.5), carbon monoxide (CO), and accelerometer measurements to estimate ventilation rate and potential dose of PM2.5. The fine particulate matter was analyzed for levoglucosan (LG) and light absorbing carbon as a surrogate for black carbon (BC). Breathing zone personal exposure concentrations of PM2.5, LG, BC, and CO were higher on burn days (P &lt; 0.05). Differences in exposure concentrations were observed between burn day tasks (P &lt; 0.05) with firefighters managing fire boundaries (holders) being exposed to higher CO and LG concentrations and less BC concentrations than those conducting lighting (lighters). While no statistical difference in PM2.5 exposure measures was observed between the two tasks, holders in the study tended to be exposed to higher PM2.5 concentrations (~1.4×), while lighters tended to have more inhaled amounts of PM2.5 (~1.3×). Our findings demonstrate possible diversity in the sources of particulate matter exposure at the fireline and suggest the potential importance of using dose as a metric of inhalation exposure in occupational or other settings., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Background: Self-efficacy, or the perceived capability to engage in a behavior, has been shown to play an important role in adhering to weight loss treatment. Given that adherence is extremely important for successful weight loss outcomes and that sleep and self-efficacy are modifiable factors in this relationship, we examined the association between sleep and self-efficacy for adhering to the daily plan. Investigators examined whether various dimensions of sleep were associated with self-efficacy for adhering to the daily recommended lifestyle plan among participants (N = 150) in a 12-month weight loss study., Method: This study was a secondary analysis of data from a 12-month prospective observational study that included a standard behavioral weight loss intervention. Daily assessments at the beginning of day (BOD) of self-efficacy and the previous night's sleep were collected in real-time using ecological momentary assessment., Results: The analysis included 44,613 BOD assessments. On average, participants reported sleeping for 6.93 ± 1.28 h, reported 1.56 ± 3.54 awakenings, and gave low ratings for trouble sleeping (3.11 ± 2.58; 0: no trouble; 10: a lot of trouble) and mid-high ratings for sleep quality (6.45 ± 2.09; 0: poor; 10: excellent). Participants woke up feeling tired 41.7% of the time. Using linear mixed effects modeling, a better rating in each sleep dimension was associated with higher self-efficacy the following day (all p values < .001)., Conclusion: Our findings supported the hypothesis that better sleep would be associated with higher levels of reported self-efficacy for adhering to the healthy lifestyle plan., (© 2021. International Society of Behavioral Medicine.)

Cocaine addiction is an important public health problem worldwide. Cognitive-behavioral therapy is a counseling intervention for supporting cocaine-dependent individuals through recovery and relapse prevention. It may reduce patients' cocaine uses by improving their motivations and enabling them to recognize risky situations. To study the effect of cognitive behavioral therapy on cocaine dependence, the self-reported cocaine use with urine test data were collected at the Primary Care Center of Yale-New Haven Hospital. Its outcomes are binary, including both the daily self-reported drug uses and weekly urine test results. To date, the generalized estimating equations are widely used to analyze binary data with repeated measures. However, due to the existence of significant self-report bias in the self-reported cocaine use with urine test data, a direct application of the generalized estimating equations approach may not be valid. In this paper, we proposed a novel mean corrected generalized estimating equations approach for analyzing longitudinal binary outcomes subject to reporting bias. The mean corrected generalized estimating equations can provide consistently and asymptotically normally distributed estimators under true contamination probabilities. In the self-reported cocaine use with urine test study, accurate weekly urine test results are used to detect contamination. The superior performances of the proposed method are illustrated by both simulation studies and real data analysis.

Background: Stress is associated with adverse birth and postpartum health outcomes. Few studies have longitudinally explored racial differences in maternal stress in a birthing population in the United States during the ongoing COVID-19 pandemic., Objective: This study aimed to do the following: (1) assess changes in reported stress before, during, and after initial emergency declarations (eg, stay-at-home orders) were in place due to the COVID-19 pandemic, and (2) assess Black-White differences in reported stress in a pregnant and postpartum population from Southwestern Pennsylvania., Methods: We leveraged data from the ongoing Postpartum Mothers Mobile Study (PMOMS), which surveys participants in real time throughout the pregnancy and postpartum periods via ecological momentary assessment (EMA) and smartphone technology. We analyzed data from a subset of PMOMS participants (n=85) who were either Black or White, and who submitted EMA responses regarding stress between November 1, 2019, and August 31, 2020, the time frame of this study. We divided data into four phases based on significant events during the COVID-19 pandemic: "pre" phase (baseline), "early" phase (first case of COVID-19 reported in United States), "during" phase (stay-at-home orders), and "post" phase (stay-at-home orders eased). We assessed mean stress levels at each phase using linear mixed-effects models and post hoc contrasts based on the models., Results: Overall mean stress (0=not at all to 4=a lot) during the pre phase was 0.8 for Black and White participants (range for Black participants: 0-3.9; range for White participants: 0-2.8). There was an increase of 0.3 points (t 5649 =5.2, P<.001) in the during phase as compared with the pre phase, and an increase of 0.2 points (t 5649 =3.1, P=.002) in the post phase compared with the pre phase (n=85). No difference was found between Black and White participants in the change in mean stress from the pre phase to the during phase (overall change predicted for the regression coefficient=-0.02, P=.87). There was a significant difference between Black and White participants in the change in mean stress from the during phase to the post phase (overall change predicted for the regression coefficient=0.4, P<.001)., Conclusions: There was an overall increase in mean stress levels in this subset of pregnant and postpartum participants during the same time as the emergency declarations/stay-at-home orders in the United States. Compared to baseline, mean stress levels remained elevated when stay-at-home orders eased. We found no significant difference in the mean stress levels by race. Given that stress is associated with adverse birth outcomes and postpartum health, stress induced by the ongoing COVID-19 pandemic may have adverse implications for birthing populations in the United States., International Registered Report Identifier (irrid): RR2-10.2196/13569., (©Serwaa S Omowale, Andrea Casas, Yu-Hsuan Lai, Sarah A Sanders, Ashley V Hill, Meredith L Wallace, Stephen L Rathbun, Tiffany L Gary-Webb, Lora E Burke, Esa M Davis, Dara D Mendez. Originally published in JMIR Mental Health (https://mental.jmir.org), 21.09.2021.)

Geographically explicit Ecological Momentary Assessment (GEMA), an extension of Ecological Momentary Assessment (EMA), allows to record time-stamped geographic location information for behavioral data in the every-day environments of study participants. Considering that GEMA studies are continually gaining the attention of researchers and currently there is no single approach in collecting GEMA data, in this paper, we propose and present a GEMA architecture that can be used to conduct any GEMA study based on our experience developing and maintaining the Postpartum Mothers Mobile Study (PMOMS). Our GEMA client-server architecture can be customized to meet the specific requirements of each GEMA study. Key features of our proposed GEMA architecture include: utilization of widely used smartphones to make GEMA studies practical; alleviation of the burden of activities on participants by designing clients (mobile applications) that are very lightweight and servers that are heavyweight in terms of functionality; utilization of at least one positioning sensor to determine EMA contexts marked with locations; and communication through the Internet. We believe that our proposed GEMA architecture, with the illustrated foundation for GEMA studies in our exemplar study (PMOMS), will help researchers from any field conduct GEMA studies efficiently and effectively.

Hemorrhagic disease (HD) is considered one of the most significant infectious diseases of white-tailed deer in North America. Investigations into environmental conditions associated with outbreaks suggest drought conditions are strongly correlated with outbreaks in some regions of the United States. However, during 2017, an HD outbreak occurred in the Eastern United States which appeared to be associated with a specific physiographic region, the Appalachian Plateau, and not drought conditions. The objective of this study was to determine if reported HD in white-tailed deer in 2017 was correlated with physiographic region. There were 456 reports of HD from 1605 counties across 26 states and 12 physiographic regions. Of the 93 HD reports confirmed by virus isolation, 76.3% (71/93) were identified as EHDV-2 and 66.2% (47/71) were from the Appalachian Plateau. A report of HD was 4.4 times more likely to occur in the Appalachian Plateau than not in 2017. Autologistic regression models suggested a statistically significant spatial dependence. The underlying factors explaining this correlation are unknown, but may be related to a variety of host, vector, or environmental factors. This unique outbreak and its implications for HD epidemiology highlight the importance for increased surveillance and reporting efforts in the future.

Background: The management of an outbreak of endophthalmitis associated with intravitreal bevacizumab represents a challenging real-time process involving identification of cases, treatment and mitigation measures during the outbreak. We summarize the clinical presentation and management of a cluster of endophthalmitis cases from contaminated bevacizumab, in addition to mathematical probabilistic assessment of the number of cases that define an outbreak., Methods: A retrospective study was conducted to assess the management of an endophthalmitis outbreak after intravitreal bevacizumab (IVB) administration. Demographic data, clinical information, individual patient management and public health reporting measures were reviewed. Outcomes of patients who received prophylactic antibiotics for endophthalmitis prevention were also reviewed. Binomial tail probability calculations were performed to determine the likelihood of clusters of endophthalmitis that could inform when an outbreak was evolving that would warrant more public health notification measures and communication., Results: Forty-five eyes of 42 patients who received IVB from a single batch were reviewed. Four cases of endophthalmitis from Granulicatella adiacens, a nutritionally-variant Streptococcus species, were treated successfully with intravitreal antibiotics ± vitrectomy. Thirty-four of the remaining 41 eyes were treated with prophylactic intravitreal vancomycin with no additional cases of endophthalmitis. Outbreak management also included CDC, ASRS and public health authority notification. Binominal tail probabilities demonstrated the rarity of clusters from a single batch (i.e. ~ 1/10,000 for 2 cases; 1/2 million for 3 cases). However, given the U.S. scale of IVB administration, there is an 87% chance of a cluster ≧ 2 and a 1% chance of a cluster ≧ 3 cases annually, which may guide outbreak management. A process diagram was developed to incorporate patient management and public health measures when an outbreak is suspected., Conclusion: Intravitreal antibiotics and vitrectomy were effective in the individual management of cases of endophthalmitis, and no serious adverse events occurred with prophylactic intravitreal vancomycin for at-risk eyes. Best practices for outbreaks should be evaluated, given their likelihood within the U.S. and the sight-threatening consequences of endophthalmitis.

Background: Prior research on the relationship between sleep and attempted weight loss failed to recognize the multidimensional nature of sleep. We examined the relationship between a composite measure of sleep health and change in weight and body composition among adults in a weight loss intervention., Methods: Adults (N = 125) with overweight or obesity (50.3 ± 10.6 years, 91% female, 81% white) participated in a 12-month behavioral weight loss intervention, with assessments of sleep, weight, fat mass, and fat-free mass at baseline, 6 months, and 12 months. Six sleep dimensions (regularity, satisfaction, alertness, timing, efficiency, and duration) were categorized as "good" or "poor" using questionnaires and actigraphy. A composite score was calculated by summing the number of "good" dimensions. Obstructive sleep apnea (OSA) was assessed in a subsample (n = 117), using the apnea-hypopnea index (AHI) to determine OSA severity. Linear mixed modeling was used to examine the relationships between sleep health and outcomes of percent weight, fat mass, or fat-free mass change during the subsequent 6-month interval, adjusting for age, sex, bed partner, and race; an additional model adjusted for AHI., Results: Mean baseline and 6-month sleep health was 4.5 ± 1.1 and 4.5 ± 1.2, respectively. Mean weight, fat mass, and fat-free mass changes from 0 to 6 months were -9.3 ± 6.1%, -16.9 ± 13.5%, and -3.4 ± 3.4%, respectively, and 0.4 ± 4.8%, -0.3 ± 10.3%, and 0.7 ± 4.1% from 6 to 12 months. Better sleep health was associated with greater subsequent weight loss (P = 0.016) and fat loss (P = 0.006), but not fat-free mass loss (P = 0.232). Following AHI adjustment, the association between sleep health and weight loss was attenuated (P = 0.102) but remained significant with fat loss (P = 0.040). Regularity, satisfaction, timing, and efficiency were each associated with weight and/or fat loss (P ≤ 0.041)., Conclusions: Better sleep health was associated with greater weight and fat loss, with associations attenuated after accounting for OSA severity. Future studies should explore whether improving sleep health, OSA, or the combination improves weight loss.

Objectives: Avian influenza virus A(H7N9) remains a threat to humans and has great potential to cause a pandemic in the foreseeable future. Antiviral treatment with neuraminidase inhibitors has been recommended to treat patients with H7N9 infection as early as possible, although evidence-based research on their effectiveness for H7N9 infection is lacking., Methods: Data from all laboratory-confirmed cases of H7N9 infection in Zhejiang Province between 2013 and 2017 were retrieved, and time-dependent survival models were used to evaluate the effectiveness of treatment with neuraminidase inhibitors to reduce the risk of mortality., Results: The final optimal model found no significant association (odds ratio 1.29, 95% confidence interval 0.78-2.15) between time to treatment with neuraminidase inhibitors and survival after controlling for age and white blood cell count. Sensitivity analyses with multiple imputation for missing data concurred with the primary analysis., Conclusions: No association was found between treatment with neuraminidase inhibitors and survival in patients with H7N9 infection using various adjusted models and sensitivity analyses of missing data imputations., (Published by Elsevier Ltd.)

Background: Designing and implementing a truly self-determined physical activity (PA) intervention has required excessive amounts of labor and expenses that, until recently, have made it prohibitively costly to implement in the field at scale., Methods: Guided by self-determination theory, and harnessing the power of consumer-grade interactive technologies, we developed the Virtual Fitness Buddy (VFB) Ecosystem. Designed to foster intrinsic motivation toward adopting PA as a lifestyle change in 6-10-year-old children, the Ecosystem features a mixed-reality kiosk which houses a personalized virtual pet for each user. Each time a child visits the kiosk, the pet (a mid-sized dog) automatically detects its owner based on the data from a child's Fitbit, assists the child in setting daily PA goals and provides tailored feedback on the child's PA progress. The pet alerts parents in real-time by sending text messages and relaying the parents' response to the child, so that parents and children can remain connected about the child's PA progress even when they are physically apart. We aim to implement the kiosk in 12 after-school sites, plus use 12 additional sites as controls, where children can still set and view progress toward their PA goals without access to a virtual pet., Conclusion: The VFB Ecosystem represents a new generation of technology-mediated health interventions for children to promote sustainable PA lifestyle changes. Because the VFB Ecosystem is a cost- and labor-effective solution that integrates consumer-grade technology with low barriers for continued use, it has the potential for rapid diffusion and widespread public health impact., (Published by Elsevier Inc.)

Background: In the United States, there are considerable racial inequities in adverse perinatal outcomes. Exposure to racism, sexism, and other forms of oppression may help explain these inequities., Objectives: To describe the application of real-time data collection using ecological momentary assessment (EMA) and smartphone technology to assess exposure to stress, racism, sexism, microaggressions, and other forms of oppression., Methods: The Postpartum Mothers Mobile Study (PMOMS) is an ongoing longitudinal cohort study that began recruitment in December 2017. Participants delivering at a hospital in Pittsburgh, PA are recruited by 29 weeks' gestation. Using smartphones and smart scales, participants complete daily surveys related to psychosocial, behavioural, and contextual factors and weigh themselves weekly for approximately 15 months. We provide a preliminary descriptive analysis of EMA self-reported measures of stress, racism, sexism, and microaggressions; and non-EMA measures of stress and major discrimination., Results: The sample (n = 230) is 63.5% White, 24.8% Black/African American, and 7% Hispanic origin. The most commonly reported item from the Major Discrimination Scale is being unfairly fired (18.1% of the sample). Of those, 31.7% and 17.1% attribute unfair firing to their gender and race, respectively. From the random EMA measures, on average, participants report experiences of racism and sexism at least once daily, in an average 12-hour day over the 4-week period. Black participants indicate about two experiences per day of racism, and White participants indicate more than 1 per day of sexism. Mean stress levels from the EMA measures were similar to the stress measures collected at baseline., Conclusions: The methods applied in PMOMS provide real-time data regarding how participants' daily experiences of stress and discrimination influence their lives. Future work will include understanding if and how these EMA measures may relate to already established measures of racism, sexism, and stress; and ultimately understanding associations with perinatal inequities., (© 2020 John Wiley & Sons Ltd.)

The majority of youth fail to get the recommended amount of physical activity (PA), and there is a precipitous decline in PA among children as they get older. Guided by self-determination theory and social cognitive theory, we designed an interactive, mixed reality PA intervention for 6-10-year-old children. Capitalizing on the features of consumer-grade interactive communication technologies, the intervention features a kiosk-based system that houses a virtual agent programmed to encourage children to set self-determined PA goals. This intervention aims to resolve many practical challenges in designing and administering a personalized, intrinsically motivated PA intervention for this age group. We pilot tested the feasibility of this kiosk across 6 weeks with n  = 42 child/parent dyads. The kiosk tracked and logged children's daily PA and engagement with the intervention without having to rely on human reporting, provided tailored evaluation and feedback whenever children requested it, informed parents about their child's PA progress, and employed a virtual agent (a dog) to offer social support to children. The virtual agent prompted users to set PA goals, and as children met these goals over time, their personalized dog became happier, more fit, and better at tricks. Each time a child engaged with the kiosk the system automatically sent a text message to his/her parent with details about the child's PA progress. The current study demonstrated the kiosk's feasibility in the field over 6 weeks, illustrating the potential of using interactive technologies as tools for disseminating self-sufficient, and truly self-determined health interventions for children at scale.

Background: There are significant racial disparities in pregnancy and postpartum health outcomes, including postpartum weight retention and cardiometabolic risk. These racial disparities are a result of a complex interplay between contextual, environmental, behavioral, and psychosocial factors., Objective: This protocol provides a description of the development and infrastructure for the Postpartum Mothers Mobile Study (PMOMS), designed to better capture women's daily experiences and exposures from late pregnancy through 1 year postpartum. The primary aims of PMOMS are to understand the contextual, psychosocial, and behavioral factors contributing to racial disparities in postpartum weight and cardiometabolic health, with a focus on the daily experiences of stress and racism, as well as contextual forms of stress (eg, neighborhood stress and structural racism)., Methods: PMOMS is a longitudinal observation study that is ancillary to an existing randomized control trial, GDM 2 (Comparison of Two Screening Strategies for Gestational Diabetes). PMOMS uses an efficient and cost-effective approach for recruitment by leveraging the infrastructure of GDM 2 , facilitating enrollment of participants while consolidating staff support from both studies. The primary data collection method is ecological momentary assessment (EMA) and through smart technology (ie, smartphones and scales). The development of the study includes: (1) the pilot phase and development of the smartphone app; (2) feedback and further development of the app including selection of key measures; and (3) implementation, recruitment, and retention., Results: PMOMS aims to recruit 350 participants during pregnancy, to be followed through the first year after delivery. Recruitment and data collection started in December 2017 and are expected to continue through September 2020. Initial results are expected in December 2020. As of early May 2019, PMOMS recruited a total of 305 participants. Key strengths and features of PMOMS have included data collection via smartphone technology to reduce the burden of multiple on-site visits, low attrition rate because of participation in an ongoing trial in which women are already motivated and enrolled, high EMA survey completion and the use of EMA as a unique data collection method to understand daily experiences, and shorter than expected timeframe for enrollment because of the infrastructure of the GDM 2 trial., Conclusions: This protocol outlines the development of the PMOMS, one of the first published studies to use an ongoing EMA and mobile technology protocol during pregnancy and throughout 1 year postpartum to understand the health of childbearing populations and enduring racial disparities in postpartum weight and cardiometabolic health. Our findings will contribute to the improvement of data collection methods, particularly the role of EMA in capturing multiple exposures and knowledge in real time. Furthermore, the results of the study will inform future studies investigating weight and cardiometabolic health during pregnancy and the postpartum period, including how social determinants produce population disparities in these outcomes., International Registered Report Identifier (irrid): DERR1-10.2196/13569., (©Dara D Mendez, Sarah A Sanders, Hassan A Karimi, Pedram Gharani, Stephen L Rathbun, Tiffany L Gary-Webb, Meredith L Wallace, John J Gianakas, Lora E Burke, Esa M Davis. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 26.06.2019.)

Background: Electronic cigarette (e-cigarette) conventions regularly bring together thousands of users around the world. In these environments, secondhand exposures to high concentrations of e-cigarette emissions are prevalent. Some biomarkers for tobacco smoke exposure may be used to characterize secondhand e-cigarette exposures in such an environment., Methods: Participants who did not use any tobacco product attended four separate e-cigarette events for approximately six hours. Urine and saliva samples were collected from participants prior to the event, immediately after the event, 4-h after the event, and the next morning (first void). Urine samples from 34 participants were analyzed for cotinine, trans-3'-hydroxycotinine, S-(3-hydroxypropyl)-N-acetylcysteine (3-HPMA), S-carboxyethyl-N-acetylcysteine (CEMA), select tobacco-specific nitrosamines (TSNAs), and 8-isoprostane. Saliva samples were analyzed for cotinine and trans-3'-hydroxycotinine., Results: Data from 28 of 34 participants were used in the data analysis. Creatinine-adjusted urinary cotinine concentrations increased up to 13-fold and peaked 4-h after completed exposure (range of adjusted geometric means [AGMs] = 0.352-2.31 μg/g creatinine). Salivary cotinine concentrations were also the highest 4-h after completed exposure (range of AGMs = 0.0373-0.167 ng/mL). Salivary cotinine and creatinine-corrected concentrations of urinary cotinine, trans-3'-hydroxycotinine, CEMA, and 3-HPMA varied significantly across sampling times. Urinary and salivary cotinine, urinary trans-3'-hydroxycotinine, and urinary 3-HPMA concentrations also varied significantly across events., Conclusion: Secondhand e-cigarette exposures lasting six hours resulted in significant changes in exposure biomarker concentrations of both nicotine and acrolein but did not change exposure to tobacco-specific nitrosamines. Additional research is needed to understand the relationship between biomarker concentrations and environmental concentrations of toxicants in e-cigarette emissions., (Published by Elsevier GmbH.)

Objective: To examine the bidirectional relationship between weight change and obstructive sleep apnea (OSA) in the context of a behavioral weight loss intervention., Patients and Methods: Adults who were overweight or obese (N=114) participated in a 12-month behavioral weight loss intervention from April 17, 2012, through February 9, 2015. The apnea-hypopnea index (AHI), a marker of the presence and severity of OSA, was assessed at baseline, 6 months, and 12 months. Linear mixed models evaluated the effect of weight change on the AHI and the effect of OSA (AHI ≥5) on subsequent weight loss. Secondary analyses evaluated the effect of OSA on intervention attendance, meeting daily calorie goals, and accelerometer-measured physical activity., Results: At baseline, 51.8% of the sample (n=59) had OSA. Adults who achieved at least 5% weight loss had an AHI reduction that was 2.1±0.9 (adjusted mean ± SE) events/h greater than those with less than 5% weight loss (P<.05). Adults with OSA lost a mean ± SE of 2.2%±0.9% less weight during the subsequent 6-month interval compared with those without OSA (P=.02). Those with OSA were less adherent to daily calorie goals (mean ± SE: 25.2%±3.3% vs 34.8%±3.4% of days; P=.006) and had a smaller increase in daily activity (mean ± SE: 378.3±353.7 vs 1060.1±377.8 steps/d; P<.05) over 12 months than those without OSA., Conclusion: Behaviorally induced weight loss in overweight/obese adults was associated with significant AHI reduction. However, the presence of OSA was associated with blunted weight loss, potentially via reduced adherence to behaviors supporting weight loss. These results suggest that OSA screening before attempting weight loss may be helpful to identify who may benefit from additional behavioral counseling., (Copyright © 2018 Mayo Foundation for Medical Education and Research. All rights reserved.)

Background: Electronic cigarette (e-cigarette) conventions bring hundreds to thousands of e-cigarette users together socially regularly across the world. E-cigarette secondhand exposures to chemicals in this environment, likely the public setting with the highest concentration of e-cigarette secondhand aerosol, have not been characterized., Methods: Air sampling for formaldehyde, acetaldehyde, acrolein, nicotine, and propylene glycol was conducted at three e-cigarette conventions and one smaller event from April 2016 to March 2017 in three states in the Southeastern United States. Volunteers attended the events as members of the public and wore backpacks containing air sampling pumps. Control sampling was conducted when venues were crowded for non-e-cigarette events. Additional control sampling was conducted in two venues when they were empty., Results: Formaldehyde and acetaldehyde concentrations during e-cigarette events were comparable to background concentrations. The median formaldehyde concentrations during events, crowded control events, and empty control events were 12.0, 10.5, and 12.5 μg/m 3 , respectively. The median acetaldehyde concentrations during events, crowded control events, and empty control events were 9.7, 15.5, and 3.5 μg/m 3 , respectively. Propylene glycol and nicotine were not detected during control sampling. The median nicotine concentration during events was 1.1 μg/m 3 . The median propylene glycol concentration during events was 305.5 μg/m 3 ., Conclusion: Results indicate e-cigarette secondhand exposures are sources of elevated nicotine and propylene glycol exposures. Secondhand exposures to e-cigarettes did not contain consistently elevated concentrations of formaldehyde or acetaldehyde. Additional research is needed to characterize exposures via inhalation to propylene glycol at concentrations measured in this study., (Copyright © 2018 Elsevier GmbH. All rights reserved.)

Objectives: To examine the effect of Florida's adoption of Statute 335.065-a law requiring the routine accommodation of nonmotorized road users (i.e., a "Complete Streets" policy)-on pedestrian fatalities and to identify factors influencing its implementation., Methods: We used a multimethod design (interrupted time-series quasi-experiment and interviews) to calculate Florida's pedestrian fatality rates from 1975 to 2013-39 quarters before and 117 quarters after adoption of the law. Using statistical models, we compared Florida with regional and national comparison groups. Semistructured interviews were conducted with 10 current and former Florida transportation professionals in 2015., Results: Florida's pedestrian fatality rates decreased significantly-by at least 0.500% more each quarter-after Statute 335.065 was adopted, resulting in more than 3500 lives saved across 29 years. Interviewees described supports and challenges associated with implementing the law., Conclusions: Florida Statute 335.065 is associated with a 3-decade decrease in pedestrian fatalities. The study also reveals factors that influenced the implementation and effectiveness of the law. Public Health Implications. Transportation policies-particularly Complete Streets policies-can have significant, quantifiable impacts on population health. Multimethod designs are valuable approaches to policy evaluations.

Electronic cigarette (e-cigarette) conventions are trade shows held across the globe to promote e-cigarette products and provide a venue for users to socialize. E-cigarette users that attend these events likely represent the most intensive e-cigarette user group. No study has characterized addiction and behavior characteristics in this population. We surveyed 131 e-cigarette users attending a large Southeastern e-cigarette convention in Fall 2015. All questions from the Fagerstrom Test for Nicotine Dependence (FTND), select questions from the Penn State Electronic Cigarette Dependence Index, and novel user behavior questions were included. In total, 25 questions were included in the survey. FTND scores were calculated for each respondent who answered all six FTND questions (n = 117). Fisher's Exact Chi square test was used to assess the relationship between addiction and behavior characteristics and FTND scores. Most respondents were classified as moderately dependent (score 5-7, 45.3% of respondents). Length of use, waking at night to use an e-cigarette, strength of cravings, strength of urges over the past week, and frequency of visiting e-cigarette blogs were significantly associated with FTND scores. E-cigarettes users have average FTND scores higher than tobacco smokers. Scores were not significantly associated with prior tobacco cigarette use. Characteristics associated with tobacco smokers' nicotine addiction, such as waking at night to smoke and strength of cravings experienced, are relevant to e-cigarette users. E-cigarettes do not contain the magnitude of toxicants in tobacco cigarettes, but e-cigarettes may produce new chemical exposures evidenced by the adverse health effects reported by some respondents.

Objective: A repeated measures study was used to assess the effect of work tasks on select proinflammatory biomarkers in firefighters working at prescribed burns., Methods: Ten firefighters and two volunteers were monitored for particulate matter and carbon monoxide on workdays, January to July 2015. Before and after workshift dried blood spots were analyzed for inflammatory mediators using the Meso Scale Discovery assay, while blood smears were used to assess leukocyte parameters., Results: Firefighters lighting with drip-torches had higher cross-work-shift increases in interleukin-8, C-reactive protein, and serum amyloid A compared with holding, a task involving management of fire boundaries. A positive association between interleukin-8 and segmented-neutrophil was observed., Conclusion: Results from this study suggest that intermittent occupational diesel exposures contribute to cross-work-shift changes in host systemic innate inflammation as indicated by elevated interleukin-8 levels and peripheral blood segmented-neutrophils.

Background: Ecological momentary assessment (EMA) assesses individuals' current experiences, behaviors, and moods as they occur in real time and in their natural environment. EMA studies, particularly those of longer duration, are complex and require an infrastructure to support the data flow and monitoring of EMA completion., Objective: Our objective is to provide a practical guide to developing and implementing an EMA study, with a focus on the methods and logistics of conducting such a study., Methods: The EMPOWER study was a 12-month study that used EMA to examine the triggers of lapses and relapse following intentional weight loss. We report on several studies that informed the implementation of the EMPOWER study: (1) a series of pilot studies, (2) the EMPOWER study's infrastructure, (3) training of study participants in use of smartphones and the EMA protocol and, (4) strategies used to enhance adherence to completing EMA surveys., Results: The study enrolled 151 adults and had 87.4% (132/151) retention rate at 12 months. Our learning experiences in the development of the infrastructure to support EMA assessments for the 12-month study spanned several topic areas. Included were the optimal frequency of EMA prompts to maximize data collection without overburdening participants; the timing and scheduling of EMA prompts; technological lessons to support a longitudinal study, such as proper communication between the Android smartphone, the Web server, and the database server; and use of a phone that provided access to the system's functionality for EMA data collection to avoid loss of data and minimize the impact of loss of network connectivity. These were especially important in a 1-year study with participants who might travel. It also protected the data collection from any server-side failure. Regular monitoring of participants' response to EMA prompts was critical, so we built in incentives to enhance completion of EMA surveys. During the first 6 months of the 12-month study interval, adherence to completing EMA surveys was high, with 88.3% (66,978/75,888) completion of random assessments and around 90% (23,411/25,929 and 23,343/26,010) completion of time-contingent assessments, despite the duration of EMA data collection and challenges with implementation., Conclusions: This work informed us of the necessary preliminary steps to plan and prepare a longitudinal study using smartphone technology and the critical elements to ensure participant engagement in the potentially burdensome protocol, which spanned 12 months. While this was a technology-supported and -programmed study, it required close oversight to ensure all elements were functioning correctly, particularly once human participants became involved., (©Lora E Burke, Saul Shiffman, Edvin Music, Mindi A Styn, Andrea Kriska, Asim Smailagic, Daniel Siewiorek, Linda J Ewing, Eileen Chasens, Brian French, Juliet Mancino, Dara Mendez, Patrick Strollo, Stephen L Rathbun. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 15.03.2017.)

K-shuff is a new algorithm for comparing the similarity of gene sequence libraries, providing measures of the structural and compositional diversity as well as the significance of the differences between these measures. Inspired by Ripley's K-function for spatial point pattern analysis, the Intra K-function or IKF measures the structural diversity, including both the richness and overall similarity of the sequences, within a library. The Cross K-function or CKF measures the compositional diversity between gene libraries, reflecting both the number of OTUs shared as well as the overall similarity in OTUs. A Monte Carlo testing procedure then enables statistical evaluation of both the structural and compositional diversity between gene libraries. For 16S rRNA gene libraries from complex bacterial communities such as those found in seawater, salt marsh sediments, and soils, K-shuff yields reproducible estimates of structural and compositional diversity with libraries greater than 50 sequences. Similarly, for pyrosequencing libraries generated from a glacial retreat chronosequence and Illumina® libraries generated from US homes, K-shuff required >300 and 100 sequences per sample, respectively. Power analyses demonstrated that K-shuff is sensitive to small differences in Sanger or Illumina® libraries. This extra sensitivity of K-shuff enabled examination of compositional differences at much deeper taxonomic levels, such as within abundant OTUs. This is especially useful when comparing communities that are compositionally very similar but functionally different. K-shuff will therefore prove beneficial for conventional microbiome analysis as well as specific hypothesis testing., Competing Interests: The authors have declared that no competing interests exist.

Cigarette smoking is a prototypical example of a recurrent event. The pattern of recurrent smoking events may depend on time-varying covariates including mood and environmental variables. Fixed effects and frailty models for recurrent events data assume that smokers have a common association with time-varying covariates. We develop a mixed effects version of a recurrent events model that may be used to describe variation among smokers in how they respond to those covariates, potentially leading to the development of individual-based smoking cessation therapies. Our method extends the modified EM algorithm of Steele (1996) for generalized mixed models to recurrent events data with partially observed time-varying covariates. It is offered as an alternative to the method of Rizopoulos, Verbeke, and Lesaffre (2009) who extended Steele's (1996) algorithm to a joint-model for the recurrent events data and time-varying covariates. Our approach does not require a model for the time-varying covariates, but instead assumes that the time-varying covariates are sampled according to a Poisson point process with known intensity. Our methods are well suited to data collected using Ecological Momentary Assessment (EMA), a method of data collection widely used in the behavioral sciences to collect data on emotional state and recurrent events in the every-day environments of study subjects using electronic devices such as Personal Digital Assistants (PDA) or smart phones., (© 2015, The International Biometric Society.)

Maternal folate status and body mass index (BMI) are independent risk factors for neural tube defects (NTD). Population-based studies have identified an inverse association between serum folate and BMI, after adjusting for intake. The objective of this intervention study was to compare the relationship between BMI and the short-term pharmacokinetic response to an oral dose of folic acid. Healthy obese (BMI 30.0 kg m(-2); n=16) and normal-weight (BMI 18.5-24.9 kg m(-2); n=16) women of childbearing age (18-35 years) were administered a single oral dose of folic acid (400 μg). Blood samples were collected over a 10-h period to evaluate the serum folate response. Fasting baseline serum folate was lower in the obese group (P=0.005); in contrast, red blood cell folate was higher (P=0.05). Area-under-the-curve for the absorption phase (0-3 h) and peak serum folate concentrations were lower in obese versus normal-weight women (P<0.005). Overall serum folate response (0-10 h) was lower in obese versus normal-weight women (repeated-measures ANOVA, P=0.001). Data suggest body distribution of folate is significantly affected by obesity, and, should pregnancy occur, may reduce the amount of folate available to the developing embryo. These findings provide additional support for a BMI-adjusted folic acid intake recommendation for NTD risk reduction.

Background: Measurement of biological indicators of physiological change may be useful in evaluating the effectiveness of stove models, which are intended to reduce indoor smoke exposure and potential health effects., Objectives: We examined changes in exhaled carbon monoxide (CO), percentage carboxy-hemoglobin, and total hemoglobin in response to the installation of a chimney stove model by the Juntos National Program in Huayatan, Peru in 2008., Methods: Biomarkers were measured in a convenience sample comprising 35 women who met requirements for participation, and were measured before and three weeks after installation of a chimney stove. The relationships between exposure to indoor smoke and biomarker measurements were also analyzed using simple linear regression models., Results: Exhaled CO reduced from 6.71 ppm (95% CI 5.84-7.71) to 3.14 ppm (95% CI 2.77-3.66) three weeks after stove installation (P < 0.001) while % COHb reduced from 1.76% (95% CI 1.62-1.91) to 1.18% (95% CI 1.12-1.25; P < 0.001). Changes in exhaled CO and % COHb from pre- to post-chimney stove installation were not correlated with corresponding changes in exposure to CO and PM2.5 even though the exposures also reduced after stove installation., Conclusion: Exhaled CO and % COHb both showed improvement with reduction in concentration after the installation of the chimney cook stoves, indicating a positive physiological response subsequent to the intervention.

Background: In developing countries, deficiencies in essential micronutrients are common, particularly in pregnant women. Although, biochemical indicators of diet and nutrition are useful to assess nutritional status, few studies have examined such indicators throughout pregnancy in women in developing countries., Methods: The primary objective of this study was to assess the nutritional status of 78 Peruvian women throughout pregnancy for 16 different nutritional indicators including fat-soluble vitamins and carotenoids, iron-status indicators, and selenium. Venous blood samples from which serum was prepared were collected during trimesters one (n = 78), two (n = 65), three (n = 62), and at term via the umbilical cord (n = 52). Questionnaires were completed to determine the demographic characteristics of subjects. Linear mixed effects models were used to study the associations between each maternal indicator and the demographic characteristics., Results: None of the women were vitamin A and E deficient at any stage of pregnancy and only 1/62 women (1.6%) was selenium deficient during the third trimester. However, 6.4%, 44% and 64% of women had ferritin levels indicative of iron deficiency during the first, second and third trimester, respectively. Statistically significant changes (p ≤ 0.05) throughout pregnancy were noted for 15/16 nutritional indicators for this Peruvian cohort, with little-to-no association with demographic characteristics. Three carotenoids (beta-carotene, beta-cryptoxanthin and trans-lycopene) were significantly associated with education status, while trans-lycopene was associated with age and beta-cryptoxanthin with SES (p < 0.05). Concentrations of retinol, tocopherol, beta-cryptoxanthin, lutein + zeaxanthin and selenium were lower in cord serum compared with maternal serum (p < 0.05). Conversely, levels of iron status indicators (ferritin, transferrin saturation and iron) were higher in cord serum (p < 0.05)., Conclusion: The increasing prevalence of iron deficiency throughout pregnancy in these Peruvian women was expected. It was surprising though not to find deficiencies in other nutrients. The results highlight the importance of continual monitoring of women throughout pregnancy for iron deficiency which could be caused by increasing fetal needs and/or inadequate iron intake as pregnancy progresses.

Ecological momentary assessment (EMA) is a method for collecting real-time data in subjects' environments. It often uses electronic devices to obtain information on psychological state through administration of questionnaires at times selected from a probability-based sampling design. This information can be used to model the impact of momentary variation in psychological state on the lifetimes to events such as smoking lapse. Motivated by this, a probability-sampling framework is proposed for estimating the impact of time-varying covariates on the lifetimes to events. Presented as an alternative to joint modeling of the covariate process as well as event lifetimes, this framework calls for sampling covariates at the event lifetimes and at times selected according to a probability-based sampling design. A design-unbiased estimator for the cumulative hazard is substituted into the log likelihood, and the resulting objective function is maximized to obtain the proposed estimator. This estimator has two quantifiable sources of variation, that due to the survival model and that due to sampling the covariates. Data from a nicotine patch trial are used to illustrate the proposed approach.

Background/objective: A study was undertaken at the United States Department of Energy's Savannah River Site (SRS), Aiken, South Carolina to investigate radionuclide activity concentrations in litter and duff from select areas at SRS. Litter (i.e. vegetative debris) and duff (i.e. highly decomposed vegetative debris) can often be the major fuels consumed during prescribed burns and have potential to release radiological contaminants into the environment., Methods: Repeated samples from 97 locations were collected systematically across SRS and analyzed for radionuclide activity. Radionuclide activity concentrations found in litter and duff were compared. As spatial trends were of interest, spatial distributions of radionuclide activity concentrations found in litter and duff and spatial dependency amongst the data were explored., Results: (7)Be, (40)K, and (137)Cs showed statistically significant proportional differences between litter and duff samples. Duff sample concentrations for (137)Cs (p < 0.0001) and (40)K (p = 0.0015) were statistically higher compared to litter samples. (7)Be activity concentrations were statistically higher in litter as compared to duff (p < 0.0001). For (40)K litter and duff samples, spatial correlation tests were not significant at p = 0.05 and the maps did not indicate any apparent high concentrations centered near possible radionuclide sources (i.e. SRS facilities). For (7)Be litter samples, significant spatial correlation was calculated (p = 0.0085). No spatial correlation was evident in the (7)Be duff samples (p = 1.0000) probably due to small sample size (n = 7). (137)Cs litter and duff samples showed significant spatial correlations (p < 0.0001 and p < 0.0001, respectively)., Conclusions: To date, few studies characterize radionuclide activity concentrations in litter and duff, and to our knowledge none present spatial analysis. Key findings show that across SRS, (137)Cs is the primary radionuclide of concern, with the highest number of samples reported above MDC in litter (51.4%) and duff samples (83.2%). However, (137)Cs litter and duff spatial trends in the maps generated from the kriging parameters do not appear to directly link the areas with higher activity concentrations with SRS facilities. The results found herein provide valuable baseline monitoring data for future studies of forest surface fuels and can be used to evaluate changes in radioactivity in surface fuels in the southeast region of the U.S., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Wildland firefighters in the United States are occupationally exposed to high levels of woodsmoke. Results from experimental studies show that exposure to woodsmoke induces inflammation. A study was conducted to investigate the effect of occupational woodsmoke exposure on inflammatory biomarkers in firefighters working at prescribed burns. Twelve U.S. Forest Service wildland firefighters at the Savannah River Site, South Carolina, volunteered to give blood samples during four prescribed burns between February and March 2011. Twenty-four paired (pre- and post-work shift) blood samples were collected using dried blood spot method to facilitate repeated sample collection. Inflammatory biomarker concentrations in blood samples were measured using the Meso Scale Discovery multi-spot assay system. Concurrent personal PM₂.₅ and CO monitoring of firefighters was conducted. Linear mixed models were used to test whether cross-work shift differences occurred in the following inflammatory biomarkers: IL-1β, IL-8, CRP, SAA, ICAM-1, and VCAM-1. IL-8 showed a significant cross-work shift difference as indicated by a post/pre-work shift ratio of 1.70 (95% CL: 1.35, 2.13; p = 0.0012). Concentrations of IL-8, CRP, and ICAM-1 increased in >50% of samples across work shift. Firefighters who lighted fires as opposed to other work tasks had the largest cross-work shift increase in IL-8. A significant cross-work shift increase in IL-8 in blood samples was observed in healthy wildland firefighters working at prescribed burns. Further research is needed to understand the physiological responses underlying the adverse effects of woodsmoke exposure, and the dose-response relationship between woodsmoke exposure and inflammatory responses.

90% of people residing in rural areas of less-developed countries rely on coal and biomass fuels for heating and cooking, leading to high exposures to the products of incomplete combustion. Three Andean communities within the Santiago de Chuco province of Peru received two different models of improved cookstoves. The impact of these stoves in reducing personal exposures and kitchen concentrations of fine particulate matter (PM(2.5)) and carbon monoxide (CO) was evaluated separately in 64 homes (32 with each stove model) using air monitoring equipment. In the community receiving stove 1, baseline aggregate 48-h personal exposure (n=27) and kitchen concentrations (n=26) of PM(2.5) were 116.4 and 207.3μg/m(3), respectively, and 48-h personal (n=25) and kitchen (n=25) CO levels were 1.2 and 3.6ppm. After introducing the new stove to this community, those exposures reduced to 68.4 and 84.7μg/m(3), and 0.4 and 0.8ppm, representing reductions of 41.3%, 59.2%, 69.6% and 77.7% respectively. In the two communities receiving stove 2, corresponding levels were 126.3μg/m(3) (n=18), 173.4μg/m(3) (n=19), 0.9ppm (n=19), and 2.6ppm (n=17) before the installation of the stoves, and they reduced to 58.3, 51.1μg/m(3) and 0.6, 1.0ppm. Overall, homes receiving stove 2 saw reductions of 53.8, 70.5, 25.8 and 63.6%. All values are statistically significant (p<0.05) with the exception of personal CO reductions in the stove 2 group. Both stoves markedly reduce both kitchen and personal levels of wood smoke exposure, which we believe has the potential to improve health and quality of life., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Ecological Momentary Assessment is an emerging method of data collection in behavioral research that may be used to capture the times of repeated behavioral events on electronic devices, and information on subjects' psychological states through the electronic administration of questionnaires at times selected from a probability-based design as well as the event times. A method for fitting a mixed Poisson point process model is proposed for the impact of partially-observed, time-varying covariates on the timing of repeated behavioral events. A random frailty is included in the point-process intensity to describe variation among subjects in baseline rates of event occurrence. Covariate coefficients are estimated using estimating equations constructed by replacing the integrated intensity in the Poisson score equations with a design-unbiased estimator. An estimator is also proposed for the variance of the random frailties. Our estimators are robust in the sense that no model assumptions are made regarding the distribution of the time-varying covariates or the distribution of the random effects. However, subject effects are estimated under gamma frailties using an approximate hierarchical likelihood. The proposed approach is illustrated using smoking data.

The immediate emotional and situational antecedents of ad-libitum smoking are still not well understood. We reanalyzed data from ecological momentary assessment using novel point process analyses to assess how craving, mood, and social setting influence smoking rate, as well as to assess the moderating effects of gender and nicotine dependence. Smokers (N = 304) recorded craving, mood, and social setting using electronic diaries when smoking and at random nonsmoking times over 16 days of smoking. Point process analysis, which makes use of the known random sampling scheme for momentary variables, examined main effects of setting and interactions with gender and dependence. Increased craving was associated with higher rates of smoking, particularly among women. Negative affect was not associated with smoking rate, even in interaction with arousal, but restlessness was associated with substantially higher smoking rates. Women's smoking tended to be less affected by negative affect. Nicotine dependence had little moderating effect on situational influences. Smoking rates were higher when smokers were alone or with others who were smoking, and smoking restrictions reduced smoking rates. However, the presence of others who are smoking undermined the effects of restrictions. The more sensitive point process analyses confirmed earlier findings, including the surprising conclusion that negative affect by itself was not related to smoking rates. Contrary to hypothesis, men's and not women's smoking was influenced by negative affect. Both smoking restrictions and the presence of others who are not smoking suppress smoking, but the presence of others who are not smoking undermines the effects of restrictions. Point process analyses of ecological momentary assessment data can bring out even small influences on smoking rate., ((c) 2011 APA, all rights reserved.)

To assess the potential impact of oral rabies vaccination (ORV) on the occurrence of raccoon rabies in the mid-Atlantic region, temporal and seasonal trends of raccoon rabies cases reported in West Virginia from 1990 to 2007 were identified with both descriptive statistical analysis and exploratory time series analysis. Raccoon rabies cases in the non-ORV region maintain an enzootic pattern and increase over time; a bimodal seasonal pattern is observed with a large peak in April and a smaller peak in August. The results of the model indicate that the effect of the ORV intervention to control raccoon rabies was statistically significant. ORV should be attempted in other enzootic raccoon rabies areas.

High-altitude populations using biofuels for household energy may be at health risk due to a combination of altitudinal stress and indoor exposures to biomass smoke. In this article, the authors measure indoor and outdoor breathing level concentrations of PM(2.5) and CO during periods of meal preparation in a convenience sample of homes above 3000 m in Cusco, Peru. From July 10 to 21, 2005, 237 measurements were taken during a pilot study at 41 residences. Results show the highest levels of PM(2.5) and CO occurred during the early morning in the kitchen when dung and wood were used. Additionally, findings suggest that residential biomass fuel combustion in Cusco results in elevated indoor PM(2.5) and CO exposure levels that are of potential human health concern, an issue that may be exacerbated by the physiological impact of living in a high-altitude environment.

To determine the significance of differences between clonal libraries of environmental rRNA gene sequences, differences between homologous coverage curves, CX(D), and heterologous coverage curves, CXY(D), were calculated by a Cramér-von Mises-type statistic and compared by a Monte Carlo test procedure. This method successfully distinguished rRNA gene sequence libraries from soil and bioreactors and correctly failed to find differences between libraries of the same composition.

Spatiotemporal patchiness in the soil environment is thought to be crucial for the maintenance of soil biodiversity. It provides diverse microhabitats (allowing resource partitioning), and presents these in a complex mosaic, such that competitors may be spatially and temporally separated (promoting patch dynamics). The objective of our study was to assess the importance of patch dynamics for the maintenance of landscape-level nematode diversity. The spatiotemporal aggregation patterns in populations of five species of the bacterivorous genus Chronogaster were analyzed for a 0.7-ha riparian wetland, during four seasons, using geostatistical methods (spatiotemporal variograms, cross-correlograms, and log-normal kriging). We found that for the three most abundant species, aggregation was significant over distances of 13-39 m, with intraspecific aggregation stronger than interspecific aggregation. In addition, species patterns appeared to be temporally dynamic: local population declines alternated with local blooms at different sites and seasons. One species was consistently present at the same few sites, but the other species showed gradual temporal decreases and increases at different locations in the wetland. Combining nematode patterns with information on soil resource distributions and Chronogaster ecology, indicated that both soil resource patchiness and repeated, but largely unpredictable, disturbances caused by local soil moisture fluctuations could promote landscape-level Chronogaster diversity by providing ample 'probability refuges.' Local species populations, reduced by competition, predation and drought, could recolonize patches either through the awakening of local dormant 'seed populations,' or through limited passive dispersal by wind, water, and phoresis. We suggest that the spatiotemporal Chronogaster data provide preliminary evidence for the importance of patch dynamics in maintaining soil nematode diversity.

Objective: To characterize ambulatory electrocardiographic results of overtly healthy Doberman Pinschers and determine associations between those results and development of dilated cardiomyopathy., Design: Cohort study., Animals: 114 (58 male, 56 female) overtly healthy Doberman Pinschers without echocardiographic evidence of cardiac disease on initial examination., Procedure: Echocardiograms and 24-hour ambulatory electrocardiograms (Holter recordings) were obtained initially and at variable intervals. The status (live vs dead) of all dogs was known at least 2 years and as long as 10 years after initial examination (mean [+/- SD] follow-up time, 4.33 +/- 1.84 years). Associations between development of dilated cardiomyopathy and number of ventricular premature contractions (VPC), age, and sex were determined., Results: 55 dogs (48%) did not have VPC on initial Holter recordings, and only 8 dogs had > 50 VPC/24 hours. The likelihood that a dog would have VPC was associated with increasing age and being male. At least 1 VPC/24 hours, and in particular, > 50 VPC/24 hours or > or = 1 couplet or triplet of VPC/24 hours, were predictive of subsequent development of dilated cardiomyopathy. Fifty-four dogs (47%) developed dilated cardiomyopathy; 12 were still alive at the end of the study, and 42 had died. Twenty-five of these 42 dogs died after the onset of congestive heart failure (CHF), 15 died suddenly before the onset of overt CHF, and 2 died of noncardiac causes. More males developed dilated cardiomyopathy than females, and dogs that died suddenly were approximately 1 year younger than those that developed CHF., Conclusions and Clinical Relevance: Results of high-quality Holter recordings may be used to identify overtly healthy Doberman Pinschers that are at a high risk for dilated cardiomyopathy.